Promoting reflection on bioethics and research ethics issues in Sub-Saharan Africa

Thursday, January 07, 2010

Starting the new year with dignity -- or not

The corks from the New Year's celebrations have hardly even been swept up, and already we have the first ugly bioethics conflict of the new decade. It about the concept of dignity, and more specifically whether the concept is coherent and useful in tackling bioethical problems. In 2003, Ruth Macklin wrote a paper in the British Medical Journal with the unambiguous title, "Dignity is a useless concept." But the concept of dignity has not made a dignified exit from the bioethics scene in the meantime. To the contrary, there have been a number of scholarly attempts to demonstrate its importance and usefulness, UNESCO's contribution to bioethics (Universal Declaration of Bioethics and Human Rights) in 2005 gave the concept of dignity a pride of place, and there are a number of bioethics-related blogs that clutch onto the concept of dignity as though their lives (and ours) literally depended on it.

A new article in the journal Bioethicstakes aim once again at the concept of dignity. The author, Alasdair Cochrane, analyzes four ways of understanding the concept of dignity, and finds them all wanting. Dignity could be understood as a person's bearing or demeanor, particularly under stress or adversity; or it could mean the inherent moral worth (a kind of property) that each of us has by simply being human; or it could mean dignity in a Kantian sense, a property derived from being a person and the forms of treatment appropriate to persons; or it could signify the kind of flourishing we as humans are capable of having as a species. Cochrane rejects all four meanings as being useful concepts for bioethics, for different reasons.

The most important of them, I think, are the arguments against the second meaning of dignity: inherent moral worth. This is probably the most popular of the four meanings that Cochrane discusses, with the Kantian concept of dignity running a close second, at least in philosophical circles. One problem with the idea of 'inherent moral worth' is that it is very difficult to articulate what this means independently of descriptions of how we think that persons ought to be treated. This means that the analysis tends to be circular, and leads to the question: why bother talking about inherent moral worth, why not concentrate on the ways people ought to be treated, and why they should be treated that way? If you say "They ought to be treated that way, because they have intrinsic moral worth", you have gotten nowhere. As Cochrane points out, one way out of the circularity is to say that humans have intrinsic moral worth -- not just because we are apt to regard them in certain ways -- but because God has given us dignity/inherent moral worth. It is an objective, inalienable property of us, written in by the Creator. Of course, if you don't believe in God, or the kind of God who does this sort of thing, then this concept falls flat. But even if you do believe in that sort of God, it may fall flat anyway: dignity in this sense can be invoked to, for example, ethically defend or object to cases of assisted suicide.

These are very damning conclusions, so you would think that they would be arrived at by rationally evaluating and countering Cochrane's arguments point by point. But they aren't. What you get instead, are mere restatements of positions ("But humans have intrinsic moral worth, dammit") and a lot of heat and rhetoric about the evils and horrors that not using the concept of dignity would inevitably lead to. It is as if all of our ethical resources were invested in that one single concept, such that if we lose it (or even just dare to criticize it), we start a slide straight into barbarism. But if the concept is that important, you would think it would have stronger and better intellectual defenders, not those who stoop to insinuation, name-calling, false attribution, and the usual muck of bad reasoning.

Perhaps those who think that the concept of dignity is useless, and the opponents of that view, should make some New Year's Resolutions. The former should promise not just to criticize dignity, but also to demonstrate that the concept of dignity could be jettisoned without loss, i.e. that the kinds of concerns expressed by their opponents could be met adequately with alternative moral concepts. Those who want to retain the concept of dignity as a important bioethical notion should promise to argue rather than ventilate, both when they approach those they disagree with as well as articulating their own, positive positions. Otherwise, the whole dignity debate will remain, well, undignified.

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